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95 lines
5.6 KiB
95 lines
5.6 KiB
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<div>
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<!-- <div class="jumbotron contact-header-label">-->
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<!-- <h1 class="display-4">Nous contacter</h1>-->
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<!-- </div>-->
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<div class="d-block d-sm-block d-md-none backtohome">
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<?php
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if( $this->uri->segment(1)!="frontoffice" && $this->uri->segment(1)!="home" && $this->uri->segment(1)!="" && ($this->uri->segment(1)!="profile" && $this->uri->segment(2)!="preferences") ){
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?>
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<?php } ?>
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</div>
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<!-- <?php
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$useremail = $userdata!=null ? $userdata->email_address : '';
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?> -->
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<div class="container">
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<div class="mc-block-title">
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Contact
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</div>
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<form id="contact_information" action="javascript:;">
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<div class="row">
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<div class="col-lg-6 col-md-6 com-sm-6 col-xs-12">
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<div class="form-label-group has-feedback">
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<input type="textbox" id="fname" name="fname" class="form-control textboxes" placeholder="Prenom">
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<label for="fname" class="fname">Prénom*
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<div class="with-fname-error"></div>
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</label>
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<div class="help-block with-errors"></div>
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</div>
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</div>
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<div class="col-lg-6 col-md-6 com-sm-6 col-xs-12">
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<div class="form-label-group has-feedback">
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<input type="textbox" id="name" name="name" class="form-control textboxes" placeholder="Nom">
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<label for="name" class="">Nom*
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<div class="with-name-error"></div>
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</label>
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<div class="help-block with-errors"></div>
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</div>
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</div>
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<div class="col-lg-12 col-md-12 com-sm-12 col-xs-12 mt-3">
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<div class="form-label-group has-feedback">
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<input type="textbox" id="sender" name="sender" class="form-control textboxes" value="" required="required" title="" placeholder="Adresse email">
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<label for="sender" class="">Adresse e-mail*
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<div class="with-sender-error"></div>
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</label>
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<div class="help-block with-errors"></div>
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</div>
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</div>
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<div class="col-lg-12 col-md-12 com-sm-12 col-xs-12 mt-2">
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<label for="nature" class="control-label">Veuillez nous indiquer l'objet de votre demande<span id="required-identifier">*</span></label>
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<div class="form-label-group has-feedback position-relative">
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<select class="form-control textboxes s1 input-lg" id="nature" name="nature">
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<option value=""></option>
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<?php foreach($natureofbusiness as $key => $row){
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?>
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<option class="nature_options" value="<?=$row->nature_of_business?>"><?=$row->nature_of_business?></option>
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<?php }?>
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</select>
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<label for="nature" class="nature">Sélectionner votre choix
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<span class="nature_required font-required"></span>
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<div class="with-nature-custom-error"></div>
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</label>
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<div class="help-block with-errors"></div>
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<div class="custom-select-icon">
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<svg xmlns="http://www.w3.org/2000/svg" width="14" height="14" fill="currentColor" class="bi bi-chevron-down" viewBox="0 0 16 16">
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<path fill-rule="evenodd" d="M1.646 4.646a.5.5 0 0 1 .708 0L8 10.293l5.646-5.647a.5.5 0 0 1 .708.708l-6 6a.5.5 0 0 1-.708 0l-6-6a.5.5 0 0 1 0-.708z"/>
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</svg>
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</div>
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</div>
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</div>
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<div class="col-lg-12 col-md-12 com-sm-12 col-xs-12 mt-3">
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<div class="form-label-group has-feedback">
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<textarea placeholder="Message*" class="form-control" rows="5" id="comment" name="comment"></textarea>
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<label for="comment" class="">Message*
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<div class="with-comment-error"></div>
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</label>
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<div class="help-block with-errors"></div>
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</div>
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</div>
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</div>
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<div class="form-group mt-2">
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<div class="btn-contact">
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<button type="submit" id="send_msg_btn_nous" class="btn btn-primary pr-5 pl-5">Envoyer</button>
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</div>
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</div>
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<div class="mb-5 mt-3 text-left"><br><br>
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<small style="color: grey;">Vous autorisez la Société
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Éditrice du Company For Madagascar, responsable de traitement, à utiliser les données personnelles figurant dans ce formulaire pour répondre à votre message. Conformément à la loi «informatique et libertés» du 6 janvier 1978 modifiée et au Règlement européen n°2016/679/UE
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du 27 avril 2016, vous bénéficiez d’un droit d’accès, de modification, de portabilité, de suppression et d’opposition au traitement des informations vous concernant. Vous pouvez exercer ces droits auprès de
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dpo@groupelemonde.fr.<br><br>
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Pour toute information complémentaire ou réclamation, vous pouvez contacter la CNIL <a href="http://www.cnil.fr/" target="blank_">(www.cnil.fr).</a></small>
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</div><br>
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</form>
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</div>
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</div>
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